Healthcare Inspection—Clinical and Administrative Concerns Related to the Podiatry Department, Lexington VA Medical Center, Kentucky

The VA Office of Inspector General (OIG) conducted an inspection to evaluate clinical and administrative concerns involving a specific podiatrist at the Lexington Veterans Affairs Medical Center (Facility), Kentucky. The OIG did not substantiate that Podiatrist A performed inadequate podiatry examinations and did not provide comprehensive care. Podiatrist A’s documentation was consistent with and generally met Veterans Health Administration criteria. No evidence of poor or inadequate care was found. The OIG could not substantiate that Podiatrist A misrepresented some patients’ clinical statuses by documenting inaccurately in the electronic health record. Direct observation at the time of the encounter would have been required to determine whether a provider is misrepresenting patients’ presenting conditions. The OIG could not substantiate that Podiatrist A “disappeared” from the clinic and did not see patients timely. No recent concerns about Podiatrist A’s attendance were identified. At the time of its unannounced observations, the OIG found that Podiatrist A was in the clinic and saw patients within the scheduled and allotted time frames. The OIG could not substantiate that Podiatrist A’s “last-minute” sick leave notification was intentional. The OIG did not substantiate that leaders ignored the issues rather than fix the problems. Leaders and managers conducted internal reviews and took actions when indicated. Through interviews and document reviews, OIG staff learned of unprofessional conduct and significant discord among Podiatry Department staff. The OIG determined that the culture of mistrust within the Podiatry Department had eroded professionalism and has the potential to place patients at risk for adverse outcomes. The OIG made one recommendation to the Facility Director to develop a clear action plan to resolve the Podiatry Department work environment issues and monitor compliance to ensure patient safety.